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Neurosurgery

Brain Stroke

A brief outline of commonly performed neurosurgical procedures of brain.

Decompressive Craniectomy:

This is a procedure which is done to control intracranial pressure (ICP) commonly in patients with Traumatic brain injury (TBI). It’s also required in selected patients with ischaemic stroke & refractory cerebral edema due to any cause like cerebral venous thrombosis, infection & postoperative edema. In this procedure, a large flap of skull bone is removed and the covering layers of brain are augmented with graft materials to allow the brain to expand. The scalp is sutured over. After recovery the skull defect can be reconstructed over a period of 4-12 wks with preserved bone flap or artificial substitutes by a procedure called Cranioplasty.

Craniotomy:

This procedure involves removal of a segment of bone of skull with fine drills tailored to the underlying pathology. The bone flap is replaced after the procedure. This is the basic procedure to have intracranial access.

Burr hole:

Small holes are drilled into the skull at desired location to drain liquid clots in Chronic subdural hematoma (CSDH). This process also allows intracranial access for external ventricular drainage (EVD), Endoscopic procedures, Biopsy, Ventriculo-peritoneal shunt, Abscess drainage etc.

Aneurysm Clipping:

A surgical procedure performed  under microscope to secure abnormal balloon like protrusions of intracranial vessels called aneurysms. This is a highly demanding surgery with a lot of precision. Preservation of normal blood circulation of brain during & after surgery with complete occlusion of aneurysm is the desired goal. CT Angiogram or Digital Substraction Angiogram (DSA) is required to know the detailed anatomy  before surgery. Selected aneurysms can be treated by embolization which is a procedure done by neuroradiologists or neurosurgeons trained in endovascular intervention.

Excision of brain tumor :

A tailored craniotomy & meticulous handling of normal brain tissue is prerequisite. Goal is maximum tumor removal without impairment of normal structures. The level of difficulty depends upon the location and size of tumor.  Extent of resection depends upon tumor type, location, blood supply, surgeon skills & equipment availability. After surgery the tissues are sent for histopathology study. Further treatment course is as per the pathology and volume of residual tumor. In selected cases Radiation and /or Chemotherapy is required.

Endoscopic Skull base surgery:

This is an advanced procedure where tumors of anterior skull base and pituitary gland can be removed by an access through the nasal cavity. This procedure is also useful for CSF rhinorrhoea & Optic nerve decompression in selected cases. The surgery is without any visible external incision. Sometimes to prevent postoperative CSF leak fat and tissue grafts are taken from thigh or abdominal wall.

Excision of Arterio-venous malformation:

Micro-vascular surgery is appropriate for selected vascular malformations. Vascular malformations are abnormal entangled blood vessels within the brain with abnormal communications and sometimes aneurysms within them. They may present with seizures, bleed or detected incidentally. An Angiogram  is required for detailed anatomy before planning surgery. Alternative treatment options are embolization and Gamma-knife Radiosurgery for selected cases.